Acute Paediatrics

Question 1

What is important anatomy in the airway of a child?

Answer 1

Large head to body size, short necks, large tongues, obligate nasal breathers, nasal passages easily obstructed, compressible flood of mouth + trachea and high anterior larynx

Question 2

What is different in anatomy in children for breathing?

Answer 2

Small total surface area for air tissue interface, lower airways small, diaphragmatic breathing, fewer type I fibres (easy fatigue) and soft non-calcified bones (recession and in-drawing)
Horizontal ribs so less expansion

Question 3

Describe children’s respiratory physiology

Answer 3

High metabolic rate/ oxygen consumption, oxygen dissociation curve shifted left in neonates (neonates tolerate slightly lower saturations), immature lung vulnerable to insult and apnoea may occur in babies

Question 4

What is the cardiovascular physiology in children?

Answer 4

Circulating volume is 70-80ml/kg, circulation changes from in-utero to ex-utero, ECG features vary with age and stroke volume increases with size
Systemic resistance progressively rises from birth and falling BP is a late sign

Question 5

What does bradycardia in children indicate?

Answer 5

Life-threatening pathology (may be seen in anorexia)
<60 bpm
Manage as arrest if no response/ poor perfusion

Question 6

What are some considerations in acute paediatrics?

Answer 6

Huge variation in shape and size, large surface area to weight ratio (rapid heat loss/ hypothermia), immature immune system and huge spectrum in intellectual ability + emotional response